Improving Planned Orthopaedic Surgery for Adults in North Central
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Improving planned orthopaedic surgery for adults in north central London We are proposing changes to how adults have surgery for bones, joints and muscles (planned orthopaedic surgery). This includes hip and knee replacements; and other surgery to hips, knees, shoulders, elbows, feet, ankles and hands. Closing date for feedback: 6 April 2020 About this consultation Why we need to make changes We are looking at how we provide planned orthopaedic Over 1.5 million people live in north central London and this number is surgery for adults in Barnet, Camden, Enfield, Haringey and expected to rise. The demand for healthcare is increasing and this will impact particularly on planned orthopaedic surgery. While many of these services are Islington (north central London) and we would like your views of good quality we know that patients’ experiences vary and could be better on our proposals. and that demand is forecast to increase. This summary explains our proposals to meet the current Waiting lists are too long challenges we face in providing planned orthopaedic surgery • In January 2019, over 10,500 residents in north central London were across north central London. We are asking for your views on waiting for planned orthopaedic surgery. our proposals, before we make a decision. We would also like • Between January 2018 and January 2019 only 79% of patients referred to hear if you have alternative proposals, and what they are. for orthopaedic surgery in north central London started treatment within A full consultation document and further information 18 weeks; in some of our hospitals, this fell as low as 65% in the winter months is available at: www.northlondonpartners.org.uk/orth_consultation Too many operations are cancelled • In 2018/19 across north central London, 530 orthopaedic operations were cancelled – 96% of these operations were cancelled on the day of surgery. What is planned orthopaedic surgery? This equates to 10 cancellations a week. This was due to the demands of Orthopaedic surgery treats damage to bones, joints, ligaments, tendons, emergency services, lack of available beds or staff. muscles and nerves (the musculoskeletal system). Patients may be referred to Demand for planned orthopaedic surgery is increasing an orthopaedic surgeon for a long-term condition that has developed over many years, such as osteoarthritis or other non-emergency damage. • The demand for planned orthopaedic surgery is expected to increase by around 9.5% by 2029. Hip and knee replacements are the most common orthopaedic surgery offered in the NHS, followed by other surgery of hips, knees, shoulders, Without change, it is unlikely that local hospitals would be able to reduce elbows, feet, ankles and hands. waiting lists; the number of cancellations would continue to grow; and we would not be well-prepared to deal with the expected increase in demand for Planned surgery is when patients have an appointment booked in services. If our proposals were approved, the NHS would continue to spend advance. It is planned treatment, following a referral to hospital by a GP the same amount of money (around £37 million) on orthopaedic services, and an assessment by specialists. It is sometimes called ‘elective’ or ‘non- however we could make much better use of this money and improve care. emergency’ care. Over time, this new way of working is expected to save money. All the NHS hospital trusts who would deliver planned orthopaedic care under these proposals have been part of developing them. We are proposing a new way to organise Our ambition planned orthopaedic surgery for adults in There are a number of benefits of organising care differently: • Access to consistently high-quality care for all patients across north north central London central London Two partnerships for planned orthopaedic care have been formed by local • Being able to meet current and future demand for services NHS hospital trusts – with University College London Hospitals (UCLH) and Whittington Health working together, and The Royal Free London Group • Physically separating emergency and planned surgery, to avoid (Royal Free, Barnet Hospital, Chase Farm Hospital) working with North last-minute cancellations Middlesex University Hospital (North Mid). • Highly-specialist staff who focus on high-volume orthopaedic surgery, and If the proposal is agreed, these partnerships could deliver real improvements become increasingly skilled at carrying it out in how we provide this care. In the future we want to ensure that patients can access high-quality planned • Two NHS hospitals with dedicated operating theatres and beds, for patients orthopaedic surgery without the risk of cancellation, in a timely manner. who need to stay overnight after their operation – Chase Farm Hospital and University College London Hospital • A choice of NHS hospitals for those needing day surgery The challenges • A choice of NHS hospitals for outpatient appointments We know that with any change there may be disadvantages for some people: • Improved education classes for patients to help them understand their operation and what to do to support their recovery • Some patients may have to travel further on the day of their operation • Appointments with a named surgeon and their surgical team, who would • Visitors may have to travel further stay with patients throughout their care, regardless of where it takes place • Some staff may have to work in a different hospital to where they usually • Rehabilitation support for patients after their surgery work, on some days of the week • Access to high dependency or intensive care units for patients needing • People with additional needs (such as those with a learning disability, additional care after their surgery or dementia) could find it confusing to go to a hospital they are not • Care coordinators to support patients with conditions such as dementia or familiar with. a learning disability to understand their care and where it might take place A list of benefits and challenges can be found in our consultation document. • More complex surgery would continue at the Royal National Orthopaedic We would like to hear your views on these during our consultation. Hospital, a super-specialist centre • Patients with other complex medical conditions, such as haemophilia, will have their surgery at the hospital which specialises in their condition • Emergency orthopaedic care would continue at all local hospitals with an accident and emergency department. What do the changes mean for patients? Where patients have care today The proposed change could affect anyone living in our five boroughs, and a small number in neighbouring areas, who might need a planned orthopaedic operation in the future. To help us in our decision-making, we’d like feedback from anyone with experience of, or an interest in, these services. Under our proposals all patients could experience a significant improvement in their care, To achieve this, some patients would have surgery in a different hospital in future, when compared with current arrangements. Around 11,000 patients currently have planned orthopaedic surgery each year across OUTPATIENT DAY SURGERY OVERNIGHT STAY 10 NHS and private hospitals. Under our proposals, 1460 patients would have their day surgery at a Barnet Hospital Chase Farm Chase Farm different hospital when compared to current arrangements and around 1360 patients who need an overnight stay for their surgery (such as hip and knee Royal Free Hospital Chase Farm Chase Farm surgery) would have their surgery at a different hospital when compared to current arrangements.* Chase Farm Hospital Chase Farm Chase Farm With the help of their GP or physiotherapist, patients would choose one of the two partnerships for their planned orthopaedic care. The choice of North Mid North Mid North Mid partnership would determine their choice of hospital for outpatient care and where they would have their surgery. UCLH UCLH UCLH Whittington Health Whittington Health Whittington Health Private hospitals Private hospitals Private hospitals *This includes patients who currently have NHS care in a private hospital North Middlesex University Where patients go for care today vs Hospital / Royal Free London Partnership where they could go under our proposals UCLH / Whittington Health Partnership Today HERTFORDSHIRE In the future The Kings Oak Hospital Chase Farm Hospital Chase Farm Hospital The Cavell Hospital Barnet Hospital ENFIELD SSC ENFIELD Royal National Royal National Orthopaedic Hospital Orthopaedic Hospital North North Middlesex Middlesex University University Hospital Hospital BARNET BARNET Highgate HARINGEY WALTHAM HARINGEY HARROW Private FOREST Hospital HACKNEY Whittington Whittington Royal Hospital Hospital Free Hospital BRENT CAMDEN Royal Free Hospital ISLINGTON Outpatient CAMDEN ISLINGTON appointment UCLH Day surgery UCLH Overnight stay National Hospital for Neurology and Neurosurgery SSC Super Specialist WESTMINSTER Centre In the future, patients will have a choice of the two partnerships for their care. The following table shows where patients could go for different elements of their care. Planned orthopaedic services today vs services under our proposals Overnight stay: Usually hip & knee surgery The table below shows the difference between the orthopaedic care available in north central London today, next to how it would look if these proposals GP GP were implemented. GP & OUTPATIENT SURGERY FOLLOW UP COMMUNITY Not available Available in some hospitals COMMUNITY APPOINTMENTS POST-OPERATIVE CARE